USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 82
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(Signature of agent of Board of Health no other) Health Oficer 15/9/40 (Official Designation) ( Date of Issue of Pertoft)/
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
( Month)
(Day)
46 (Year)
19 | HEREBY CERTIFY,
Oct 20
19.46
to
Nic 5
1946
i just saw him alive on.
. 19 46, death is said to
have occurred on tha date stated above, at
11 40
Immediate oause of death
Ecucina y 1 costata
0
IMPORTANT
3 yes
Due to
Due to
Caravana q
Smaal
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Physician Underline the cause to which death should be charged st .. tistically.
20 Was disease or injury in any way related to oogupation of deocesed ?.
if ao, specify
( Signed)
Have adell
M. D.
(Address) 200P teabrott Date 18006 1946
21
Hope
Place of Burial, Cremstion or Removal.
(City or Town)
DATE OF BURIAL
December 9
$6
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Howard S Quenulet
Recalved and Aled DEG-1-04946
19
( Registrar)
100m-(g)·1.45-15510
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46. Seotion 10, requires physiolans to insert a reolta! to that offoot. PARENTS
Winthrop
(City or Town)
St.
{give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR) 2
St.
( If nonresident, give city or town and State)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
66
Duration
Mejor findings:
Of operations
Prestala
Date of.
1943
Of autopsy
.
........
What test confirmed diagnosis ?
5
worcester
5
Thet I attended deosased from
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which It has been engaged, insert iu the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary ind the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- ion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- een hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its gent appointed to issue such permits, or if there is no such board, from he clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving omb to another in the same cemetery, until he has received a permit from he board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original nterment, by a satisfactory certificate of the attending physician, if any, s required by law, or in lieu thereof a certificate as hereinafter provided. f there is no attending physician, or if, for sufficient reasons, his certificate annot be obtained early enough for the purpose, or is insufficient, a physi- ian who is a member of the board of health, or employed by it or by the electmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- al examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within he commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the indertaker desiring to make such removal shall constitute a permit for uch removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten or chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
1
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy. sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper -- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
-305
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-10-'39. No. 8427-g
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Milford
(State or country) Mass
15 MAIDEN NAME
OF MOTHER
Mary Ann Duggan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Milford
Mass
17 Mary C Nestor Fay
Relation, if any
Informant.
(Address)
19 Wilshire St Winthrop Mas's
A TRUE COPY.
Clifford IsSmith
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Dec 9 1946
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ...
Dec 6
1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Coronary thrombosis
20 Accident, suicide, or homicide (specify)
Date of occurrence .. .19
Where did Injury occur ?. (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place?
Manner of
Injury
Nature of
Injury
While at work ?
Was there an autopsy ?.
21 Was disease or Injury la any way related to occupation of deceased ?.
If so, specify.
(Signed)
WAR Chapin
. M. D.
(Address)
o.p.f.ld
Date 12-6 1946
22 winthrop winthrop Mass
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
Dec 9
1946
23 NAME OF
FUNERAL DIRECTOR
John F O'Maley
ADDRESS
Winthrop Mass
Received and filed
19
JAN 7 1017
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
HAMPDEN (County) SPRINGFIELD
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
SPRINGFIELD (City or town making return)
Registered No.
231.
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
Ambrose Fay
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Wilshire St
Winthrop Mass
St.
Dead on arrival
years
months
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Married
5c If married, widowed, or divorced
HUSBAND of
Mary C Nestor
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
40
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8 46
AGE
Years.
Months.
Days
If less than I day Hours
Minutes
Usual
9 Occupation:
Manager
Industry
10 or Businesst
023-01-6111
Il Social Security No.
Brink's Inc-Bank Express
12 BIRTHPLACE (City)
Blackstone
(State or country)
Lass
13 NAME OF
FATHER
James H Fay
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state) In this community1 k yrs. mos. days.
(a) Residence. No ......
(Usual place of abode)
Length of stay: In hospital or institution ..... o.s.pita.l.
No ...
(City or Town) Mercy Hospital-Dead on arrival
wife
(Specify type of place)
1
١
.301 A 1
1
PLACE OF DEATH
Suffolk ... (County )
Winthrop
-
No.
(City or Town) 46 Washington Ave.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 232
Registared No. f (If death occurred in a hospital or institution, SŁ
't give its NAME instead of street and numher)
2 FULL NAME
Sarah L Roberts
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
35 Birch Ka.
St.
(If nonresident, give city or town and State
Length of stay: In nowoitel or Institution
( Before death )
( Specify whether )
years
months
6
days.
In this community 25 yrs.
mon.
dayı
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
5e If married, widowed, or divorced
HUSBAND of
(or) WIFE of
{ Husband's name in full)
6 Age of husbend or wife if elive yeers
7 IF STILLBORN, enter that fect here.
8
11 Years
8
Months
14 Days
AGE
If less then 1 day
Hours
Minutes
Usual
9 Occupation:
Housewife
Industry
At Home
11 Social Security No.
None
chelsea
12 BIRTHPLACE (City)
( Siate or country)
Mass.
13 NAME DF
FATHER
Charles D Addison
14 BIRTHPLACE DF
FATHER (Clty)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Alma Wheeler
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Unable To Obtain
17 George Roberts
Relation, if any
Informant ( Address) CITIT House CTIFE ++ Ave. WinthroPOTE OF BURIAL.
I HEREBY CERTIFY that a satisfactory standard certifiosta of deeth was filed with me BEFORE the burial or transit permit was istued ? Walter A. Lakers
(Signature of Agent of Board of Health or other) 12/10/76
(Date of Issue of Peymit)
MEDICAL CERTIFICATE OF DEATH
18 DATE DF
DEATH
December
7.7,
( Month)
(Day)
1946 (Year)
19 | HEREBY CERTIFY,
That i attended deosased from
may 10,
,
1944
to
Decr 7,
1946
I last saw her alive on.
19466 death is said to
have occurred on the date stated above, a
9:20 Pm
Duration
Immediate osuse of death.
Cerebral / de
IMPORTANT
Due to
Due to
Other conditions
( Include pregnancy within 3 months of death)
Mejor findings :
Di operations
Of autopsy
What test confirmed diegnosis ?
Clinical Signs
IMPORTANT
Physician
Underline the cause to which death should he charged « .. tistically.
20 Was disease or injury in any way related to occupation of deceased ? 200 if so, specify ..
( Signed )
....... . M. D.
( Address)
Date De2 10 1946
21
woodlawn
Everett
Place of Burial, Cremation or Removal.
(City or Town)
December 10
22 NAME OF
FUNERAL DIRECTORYceux
ADDRESS
Riway wywoles
Received and Ried. DEC 30 1946
(Oficial Designation)
( Registrar)
100m-(g)-1-45-15510
extract from the taws on back of certificate. if deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physiolans to insert a recital to that offoot. PARENTS
PHYSICIAN . IMPORTANT
(Was deceased 2
U. S. War Veteran,
if so specify WAR)
(a) Residenca. No.
(Usual place of abode)
Nurseing Home
Female
White
10 or Business :
Date of
-
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given aud the physician certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . .. Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
01 A
-
1
PLACE OF DEATH
Suffolk (County)
Tinthron
(City or Town)
14 Seymour St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
233. ....
St. § (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Mary E. Duffy
( Devine )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Rasidenca.
No.
14 Seymour St.
( Usual place of abode)
Length of stay: In Ansoltal or Institution
( Before death)
( Specify whether)
yeara
months
days.
In this community 20 yra.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Tidowed
5a If married, widowed, or divoroed
HUSBAND of
(or) WIFE of
BartH&'TerietDriein full)
( Husband's name In full)
6 Age of husband or wife if aliva years
7 IF STILLBORN, enter that fact here.
8
82
AGE
Years
Months
Days
If less than 1 day
Hours
Minutas
Usual
9 Occupation :
Housewife
Industry
10 or Business :
Own Home
11 Social Security No.
Galway
12 BIRTHPLACE (City)
( State or country)
Ireland
13 NAME OF
FATHER
Thomas Devine
14 BIRTHPLACE DF
FATHER (City)
Calway
(State or country)
Ireland
15 MAIDEN NAME
DF MOTHER
Helen Ward
16 BIRTHPLACE OF
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